Medicaid Innovation Accelerator Program (IAP)

Assessing SUD Provider and Service Capacity

National Webinar SeriesMay 2, 20173:30pm – 5:00pm ET

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Logistics

• Please mute your line & do not put the line on hold • Use the chat box on your screen to ask a question or

leave comment– Note: chat box will not be seen if you are in “full screen” mode– Please also exit out of “full screen” mode to participate in

polling questions

• Moderated Q&A will be held periodically throughout the webinar– Questions submitted via the chat box will be prioritized

• Please complete the evaluation in the pop-up box after the webinar to help us continue to improve your experience

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Purpose & Learning Objectives

• Introduction and Overview• Getting Started: Developing a Provider Network

Inventory• Identifying and Using Data for Your Network Inventory

– Common Data Resources– Discussion Break– Leveraging Information from Managed Care Plans and Providers– Discussion Break

• Wrap Up & Next Steps

Agenda

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Speaker/ Facilitator

• John O’Brien, MS• Senior Consultant,

Technical Assistance Collaborative

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Speaker (1/5)

• Kimberly Johnson, PhD• Director, Center for

Substance Abuse Treatment, SAMHSA

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Speaker (2/5)

• Philip Chvojka, BS• Departmental Specialist II,

BHSIS Coordinator, Michigan Department of Health and Human Services

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Speaker (3/5)

• Angie Smith-Butterwick, MSW

• Women’s Treatment Specialist, Michigan Department of Health and Human Services

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Speaker (4/5)

• Kate Neuhausen, MD, MPH

• Virginia Medicaid Chief Medical Officer

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Speaker (5/5)

• Melanie Boynton, MPA• Virginia Medicaid Office of

Data Analytic

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John O’Brien, MSKimberly Johnson, PhD

Getting Started: Developing a Provider Network Inventory

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Clarifying the Purpose of a Network Inventory

• Why do you need an Inventory?– Understand existing service capacity for current Medicaid

services– Understand existing service capacity for potential Medicaid

services – Understanding changes that will need to be made:

• Authorities• Provide contracts• MCOs contracts

– Budget implications of adding capacity

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Designing a Network Inventory

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Using the Inventory Information

• How Will Gaps be Identified?– Keep it Simple: No or a few providers may be best indicator

• What is the Strategy for Addressing Gaps?– Short Term (90-180 Days)

• Adding capacity to existing providers• Medicaid reimbursement for state-only services

– Longer Term• Adding new providers • Adding new services

– What are the plans to bridge existing need with addressing longer term gaps?

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Philip Chvojka, BSAngie Smith-Butterwick, MSW

Identifying and Using Data for Your Network Inventory

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Accessing Existing Provider Inventories

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Michigan’s Sub-State Regions

• Ten Prepaid Inpatient Health Plans (PIHPs) for the 83 Counties

• PIHPs create, contract with, and monitor the provider networks in their regions

• Michigan Department of Health and Human Services contracts with PIHPs, and the PIHPs contract with the 340+ providers

• Major providers have contracts with multiple PIHPs

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The Need to Rely on Multiple Data Sets

• Multiple data sets needed to fully understand provider attributes:– Name, location, contact information– License number, licensure status, service eligible to be delivered

under the license– American Society of Addiction Medicine Criteria Level– Accreditation (required by contract)– National provider identifier number– Populations served– Funding eligibilities accepted

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Common Data Resources

• Behavior Health Treatment Episode Data Set (TEDS)• 837 Encounter Procedure Codes and Modifiers• Licensing and Regulatory Agency (LARA) website• SAMHSA Treatment Locator Website• N-SSATS• I-BHS log-in• PIHP documentation of their provider panel• Provider survey(s) (example: ASAM database)• Provider site visits

Discussion & Questions

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Kate Neuhausen, MD, MPHMelanie Boynton, MPA

Addiction Recovery Treatment Services (ARTS) Overview

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Transforming the Delivery System for Community-Based SUD Services

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ASAM Levels of CareASAM Level of Care Placement Setting

4Medically Managed Intensive Inpatient • Acute Care General Hospital - Inpatient Detox in Medical Beds

3.7Medically Monitored Intensive Inpatient Services

(Adult) Medically Monitored High-Intensity Inpatient Services

(Adolescent)

• Inpatient Psychiatric Unit • Freestanding Psychiatric Hospital• Community-Based Facility

3.5Clinically Managed High-Intensity Residential Services

(Adults) / Medium Intensity (Adolescent)3.3

Clinically Managed Population-Specific High-Intensity Residential Services (Adults)

• Community-Based Facility Licensed for SA Residential Treatment Services

• Specialty Unit in a Health Care Facility

3.1Clinically Managed Low-Intensity Residential Services

• Substance Abuse Group Home • Substance Abuse Halfway House

2.5Partial Hospitalization Services

2.1Intensive Outpatient Services

• Licensed Program at a Health Care Facility or Community Provider

1Outpatient Services • Outpatient Services

0.5Early Intervention

• Emergency Departments, Primary Care Clinics, FQHCs, CSBs, Health Departments, Pharmacies, etc.

Opioid Treatment Program (OTP) • Public and Private Methadone Clinics

Office-Based Opioid Treatment (OBOT) • CSBs, FQHCs, Outpatient Clinics, Physician’s Offices

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Office-Based Opioid Treatment (OBOT)

Settings and Care Model

• CSBs, FQHCs, outpatient clinics psychiatry practices, primary care clinics• Provide Medication Assisted Treatment (MAT) - use of medications in

combination with counseling and behavioral therapies that results in successful recovery rates of 40-60% for opioid use disorder compared to 5-20% with abstinence-only models

• Supports integrated behavioral health - buprenorphine waivered practitioner with on site credentialed addiction treatment professional (e.g., licensed clinical psychologist, LCSW, LPC, licensed psychiatric NP, etc.) providing counseling to patients receiving MAT

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Office-Based Opioid Treatment (OBOT) Cont’d

Payment Incentives

• Buprenorphine-waivered practitioner in the OBOT can bill all Medicaid health plans for substance use care coordination code ($243 PMPM) for members with moderate to severe opioid use disorder receiving MAT

• Can bill higher rates for individual and group opioid counseling• Can bill for Certified Peer Recovery Support specialists

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Comprehensive Approach to MAT Capacity

Targeted Provider Recruitment

• OTPs: Summit and Presentation to Virginia Association of MAT Professionals

• OBOTs: Presentations at conferences for Community Service Boards and FQHCs; meetings with senior leadership and Boards of CSBs, FQHCs, and health systems

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Comprehensive Approach to MAT Capacity Cont’d

Provider Training and Ongoing Support

• Virginia Department of Health Addiction Disease Management Courses with Buprenorphine Waiver Training trained over 750 physicians, NPs, behavioral health clinicians, and clinic administrators

• Project ECHO grant from National Governors Assoc will provide ongoing support to new waivered physicians via telemedicine

• OBOT Quality Collaboratives will meet quarterly• Ongoing education of OTP leaders and clinicians

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ARTS Provider Inventory (1/4)

ARTS Provider Inventory (2/4)

ARTS Provider Inventory (3/4)

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• VA Department of Behavioral Health validation of qualified providers (licensing data)

• Standardization ensured by Medicaid contractor who certified residential providers

• Defining inpatient detox facilities

Data Validation

ARTS Provider Inventory (4/4)

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Program and Analytics Partners

Office of Data Analytics Bhaskar Mukherjee (Director) Sai Arika Melanie Boynton Rashmi Gupta Matt Harrison Deepa Harsh Rhonda Newsome Steve Pacyna Jim Starkey

Program (CMO, Behavioral Health, Managed Care Teams Dr. Kate Neuhausen Brian Campbell Fuwei Guo Ashley Harrell Lacy Heiberger Tom Lawson Tammy Whitlock

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Medicaid Members with Substance Use Disorder Diagnoses

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Impacted Communities

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Before ARTS Medicaid Provider Network Adequacy Opioid Treatment Program

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After ARTS Medicaid Provider Network Adequacy Opioid Treatment Program

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Before ARTS Medicaid Provider Network Adequacy Residential Treatment

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After ARTS Medicaid Provider Network Adequacy Residential Treatment

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*NEW* Medicaid Provider Network Adequacy Office Based Opioid Treatment

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Ensuring Provider Network Adequacy

• Maps fuel honest dialogue about the challenges and opportunities for health plans for provider recruitment

• Visualizations also spur discussion about data collection/extraction challenges

• Gives Medicaid needed feedback about what health plans need for success (e.g. difficulties contracting with certain providers)

• Quick appreciation of access gaps• Bringing us closer to our goal of

adequate member access40

We All Get There

Together

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Polling Question (1/3)

• Does your state have a process in place to assess SUD service need and treatment capacity?– Yes– No– Unsure

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Polling Question (2/3)

• Has your state conducted that process in the past 24 months?– Yes– No– Unsure

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Polling Question (3/3)

• Did the data inform any of the following efforts?– MCO contracting strategies– Provider contracting strategies– Budget/legislative requests– Purchasing strategies across agencies– Adding benefits

Discussion & Questions Cont’d

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Webinar Summary: Key Take Away Points

• There is a need for new approaches to assessing provider network capacity– Particularly with regard to ASAM levels and MAT capacity

• The process will be unique to each state, and dependent on data availability, staff capacity, ability to leverage information obtained by partners, the goals of the state, and how gaps are assessed and remedied

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Thank You!

Thank you for joining us for this National Dissemination Webinar!

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